Provider Demographics
NPI:1205938727
Name:FIVE STAR MEDICAL TRANSPORT
Entity type:Organization
Organization Name:FIVE STAR MEDICAL TRANSPORT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:MAGDALENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-429-4701
Mailing Address - Street 1:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91912-0752
Mailing Address - Country:US
Mailing Address - Phone:619-429-4701
Mailing Address - Fax:619-429-3512
Practice Address - Street 1:895 PALOMAR ST
Practice Address - Street 2:SUITE E
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2627
Practice Address - Country:US
Practice Address - Phone:619-429-4701
Practice Address - Fax:619-427-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01126FMedicaid